title: Case study: application of isometric progressive resistance oropharyngeal therapy using the Madison Oral Strengthening Therapeutic device.
abstract: OBJECTIVE
  Isometric progressive resistance oropharyngeal (I-PRO) therapy improves swallowing function; however, current devices utilize a single sensor that provides limited information or are prohibitively expensive. This single-subject study presents results of I-PRO therapy, detraining, and maintenance using the 5-sensor Madison Oral Strengthening Therapeutic (MOST) device combined with upper esophageal sphincter (UES) dilatation.
  
  
  METHODS
  A 56-year-old female nurse who was 27 months post stroke and subsequent to traditional behavioral interventions and UES dilatations presented limited to gastrostomy tube intake only and expectorating all saliva. She completed 8 weeks of I-PRO therapy, 5 weeks of detraining, and 9 weeks of I-PRO maintenance (reduced frequency) followed by a third UES dilatation post intervention. Data included diet inventory, lingual pressures (MOST), lingual volume (magnetic resonance imaging), postswallow residue (videofluoroscopy), UES and pharyngeal pressures (high-resolution manometry), and quality of life (QOL).
  
  
  RESULTS
  Findings after 8 weeks of I-PRO therapy were progression to general oral diet, 15 lb weight gain, increased isometric pressures (Δ ≯16 kPa) with transference to swallowing pressures, increased lingual volume (8.3%), reduced pharyngeal wall residue (P = .03), increased pharyngeal pressures (Δ ≯ 43 mm Hg) and increased UES opening (nadir) pressures (Δ ≯ 9 mm Hg) with improved temporopressure coordination across the pharynx, and improved QOL. After detraining, decreased isometric pressures and reduced UES opening were noted. After I-PRO maintenance, isometric anterior lingual pressures returned to levels noted after the 8 weeks of intervention.
  
  
  CONCLUSIONS
  I-PRO therapy, facilitated by the MOST device combined with instrumental UES dilatation, improved swallow safety, increased oropharyngeal intake, and facilitated UES opening while enriching QOL.
authors.affiliation: Department of Medicine, University of Wisconsin, Madison, Wisconsin Geriatric Research Education Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.
authors.forename: Junerose
authors.initials: J
authors.lastname: Juan
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Hind
authors.forename: Corinne
authors.initials: C
authors.lastname: Jones
authors.forename: Timothy
authors.initials: T
authors.lastname: McCulloch
authors.forename: Ron
authors.initials: R
authors.lastname: Gangnon
authors.forename: JoAnne
authors.initials: J
authors.lastname: Robbins
mesh_terms: D003679:Deglutition; D003680:Deglutition Disorders / Q000209:etiology / Q000534:rehabilitation*; D049631:Esophageal Sphincter, Upper / Q000503:physiopathology*; D005081:Exercise Therapy / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006801:Humans; D008365:Manometry; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010291:Paresis / Q000150:complications / Q000534:rehabilitation*; D010614:Pharynx / Q000503:physiopathology; D026741:Physical Therapy Modalities; D011312:Pressure; D013997:Time Factors; D014059:Tongue / Q000503:physiopathology
keywords: deglutition; dysphagia; rehabilitation; strengthening; stroke